Developmental & Eating Disorders

Week 13

What is ADHD | 4

• Attention Deficit Hyperactivity Disorder = Dopamine deficient

• Overactive dopamine transporters

• Too many dopamine transporters

• Too little endogenous dopamine (or a mixed of these)

What are the functions of dopamine | 2

• Endogenous reward

• Affects memory, movement, motivation, mood, attention, etc

What is the result of having ADHD

Dopamine-seeking behaviours

What is ADHD-Inattentive | 4

Distractibility, forgetfulness, common in females n likely to have internalizing disorders (anxiety n depression)

What is ADHD-Hyperactive | 4

Impulsivity, talks excessively, common in males n likely to have co-occuring externalizing disorders (ODD n CD)

What is ADHD-Combined

ADHD-attentive n ADHD-hyperactivity

What stimulants are used to manage ADHD | 3

• Amphetamine n dextroamphetamine (adderall)

• Methylphenidate (concerta)

• Lisdexamfetamine (vyvanse)

What are non-stimulants that help manage ADHD | 2

• Clonidine (kapvay)

• Atomoxetine (strattera)

What is ASD | 2

• Autism spectrum disorder

• Developmental disability - differences in brain (anatomically n physiologically)

What is the diagnostic criteria for ASD | 4

• Social interaction/communication difficulties

• Restricted/repetitive behaviours

• Limited/specific interests

• Sensory differences

What does ASD look like

It looks like a variable wheel

What is ASD level 1 | 3

• Requiring support

• Difficulty initiating social interactions

• Organization n planning problems can hamper independence

What is ASD level 2 | 3

• Requiring substantial support

• Social interactions limited to narrow special interests

• Frequent restricted/repetitive behaviours

What is ASD level 3 | 3

• Requiring very substantial support

• Severe deficits in verbal n nonverbal social communication skills

• Great distress/difficulty changing action or focus

What is down syndrome (trisomy 21) | 3

• Chromosomal defect which occurs during fetal development

• Third copy of chromosome 21

• Mid-severe intellectual impairment

What are the typical features of someone w/down syndrome | 4

• Round head, flat occiput, enlarged tongue

• Wide-set, upturned eyes

• Heart defects, thyroid issues

• Hearing n vision problems

What are we concerned about for pts w/down syndrome | 2

• Higher risk of medical conditions (cardiac sensory, endocrine - diabetes, neurological - epilepsy, haematological)

• Airway management can be difficult due to facial n airway anatomy

What is FASD | 2

• Fetal alcohol spectrum disorder

• Caused by alcohol use during pregnancy

What are the symptoms of FASD | 5

• Low body weight

• Hyperactivity

• Learning disabilities, poor memory, attention, judgement n reasoning

• Hearing/vision impairment

• Small head size, short nose, flat face w/smooth philtrum

What is cerebral palsy | 2

• Non-progressive, bilateral neuromuscular disorder in which voluntary muscles are poorly controlled

• Caused by developmental brain insults in utero at birth or postpartum infections (encephalitis/meningitis)

What is cerebral palsy characterized by | 5

• Spasticity in limbs

• Altered muscle tone

• Lack of balance/muscle coordination

• Underdeveloped limbs

• May have a intellectual disability

• Symptoms can be mild to severe

What is spasticity

Stiffness in muscles that can lead to uncontrollable spasms

What is cystic fibrosis | 2

• Chronic dysfunction of endocrine system (genetic)

• CFTR gene - changes water transport

What does cystic fibrosis target | 3

• Primarily respiratory n digestive

• Creates very thick sticky mucous inside organs - lungs n pancreas

• Affects stomach function

What is the respiratory symptomology in cystic fibrosis | 2

• Thick, mucous buildup in lungs - difficult to clear

• Tachypnea, productive cough, SOB, barrel chest, cyanosis, clubbed fingers

What are the treatments for respiratory symptomology | 3

• Manually dislodging mucous

• Oscillating positive expiratory pressure (PEP)

• Vibrating vest

What are the digestive symptoms for cystic fibrosis | 3

• Gastroparesis (delayed emptying)

• Pancreatic blockage - limited digestion

• Nutrient deficiencies n growth suppression

What is the life expectancy for pts w/cystic fibrosis | 2

• May only live to teenage years

• W/aggressive n proactive management, can be improved to 30s

What are the 5 different types of eating disorders

• Bulimia nervosa

• Anorexia nervosa

• Binge eating disorder

• Avoidant-restrictive food intake disorder (ARFID)

• Pica

What is bulimia nervosa

Overeating then significant calorie restriction

What is the purging type of bulimia nervosa | 2

• Bingeing - eating large amounts of food in short timeframes

• Purging - vomiting or laxatives

What is the non-purging type of bulimia nervosa | 2

• Bingeing - eating large amounts of food in short timeframes

• Compensation - excessive exercise or fasting

What is the frequency for bulimia nervosa

Occurs in cycles - can repeat multiple times a day

Who is most affected by bulimia nervosa | 3

• Females - starts in teenage years

• Maintain normal/above average body weight

• Not treated until 30-50yrs

What are the outward signs of bulimia nervosa | 3

• Sore/inflamed throat

• Marks on knuckles (russell’s signs)

• Dental erosion

What is anorexia nervosa | 2

• Distorted body image (fear of weight gain)

• Common in younger females

What does anorexia nervosa include | 3

• Minimal eating

• Purging behaviours

• Excessive exercise

What are the external signs of anorexia nervosa | 6

• Extremely low body weight

• Visible skeletal structure

• Lanugo (soft hair all over body - to stay warm)

• Marks to knuckles n dental erosion

• Dry brittle hair

• Dry sallow skin

What are other signs of anorexia nervosa | 2

• Absent menstruation

• Osteoporosis (low estrogen, high cortisol, break bones easily)

What do pts w/bulimia n anorexia nervosa experience | 3

• Abdominal pain n constipation

• Result of irregular/absent menstruation (difficult to rule out pregnancy)

• Cause significant electrolyte imbalances

What is hypokalaemia

Loss of potassium via purging

What can hypokalaemia cause | 4

• Hypokalaemic nephropathy (destruction of renal tubules, kidney failure)

• Arrhythmias (heart relies on Na/K+ pump

• Muscle weakness/cramping (respiratory muscles - SOB)

• Slowed digestion (constipation n abdominal distension)

What is hyponatremia | 4

• Altered sodium: water ratio

• Restricted food intake w/sustained H2O intake

• Worsened by SSRI meds

• Higher risk of ICP

What is SSRI | 3

• Selective serotonin reuptake inhibitors (anti-depressants)

• Can cause SIADH (syndrome of inappropriate antidiuretic hormone)

• Causes kidneys to retain more H2O than usual

What are signs of chronic hyponatremia | 4

• Headache n dizziness

• Lethargy

• Nausea n vomiting

• Muscle cramps

What are signs of acute hyponatremia | 4

• Brain swelling

• Confusion

• Seizure

• Coma

What is metabolic alkalosis | 2

• Common w/vomiting

• Chronic loss of H+ n Cl- (stomach acid)

What are signs of metabolic alkalosis | 2

• Muscle spasms, agitation

• Seizures, coma

What is important to note about metabolic alkalosis

Monitor ETCO2 - hypercapnea is common (HIGH)

What is metabolic acidosis | 3

• Common w/laxative use

• Ketoacidosis - acidic ketones produced from fat breakdown

• Chronic loss of bicarbonate ions (basic) - through stool n urine

What are symptoms of metabolic acidosis | 4

• Increased HR

• Breathing changes (rapid/deep initially, slow/deep later)

• Confusion, nausea, vomiting

• Weakness, lethargy

What is important to note about metabolic acidosis

Monitor ETCO2 - Hypocapnea is common (LOW)

What is binge eating disorder

Eating large amounts of food in short timeframes

What is important to note about binge eating disorder | 3

• No purging behaviours or compensation

• Usually affects woman

• Usually present as overweight/obese

What are signs of binge eating disorder | 5

• Eating when not hungry

• Continuing to eat until uncomfortably full

• Overeating as emotional/stress response

• Feelings of guilt/shame around eating

• Eating secretively

What is avoidant-restrictive food intake disorder (ARFID) | 5

• Extreme pickiness w/food

• Avoidance of food based on colour/texture/sensation

• Fear response w/certain foods

• Vomiting/gagging w/certain foods

• Dependent on nutritional supplements (external feeding tubes maybe)

Who is ARFID common in | 2

• In children, can remain in adulthood if untreated or treatment unsuccessful

• Co-occurs w/autism

What is pica

Persistently ingesting substances w/no nutritional value

What are some examples of pica | 5

• Dirt, soil, sand, stones, ice

• Chalk, paper, soap

• Pieces of metal, buttons, coins, batteries

• Hair, feces, charcoal, etc